Guide apparatus for delivery of an elongate device and methods of use

ABSTRACT

An apparatus for guiding an elongated flexible instrument comprises a variable-length support assembly including a first end, a second end, a plurality of support member pairs, and a plurality of eyelets movably coupled to at least one support member pair and configured to receive the elongated flexible instrument. The variable-length support assembly is configured to selectively transition from a compressed configuration to an expanded configuration along a longitudinal central axis, and the plurality of eyelets are adapted to support the elongated flexible instrument as the elongated flexible instrument is advanced along the longitudinal central axis. Each of the plurality of eyelets includes a tapered alignment member configured to contact a tapered alignment member of an adjacent eyelet to move the plurality of eyelets into alignment along the longitudinal axis as the variable length assembly transitions from the expanded configuration to the compressed configuration.

RELATED APPLICATIONS

This patent application is the U.S. national phase of InternationalApplication No. PCT/US2017/041160, filed Jul. 7, 2017, which designatedthe U.S. and claims priority to and the benefit of the filing date ofU.S. Provisional Patent Application 62/359,957, entitled “GUIDEAPPARATUS FOR DELIVERY OF AN ELONGATE DEVICE AND METHODS OF USE,” filedJul. 8, 2016, all of which are incorporated by reference herein in theirentirety.

FIELD

The present disclosure is directed to systems and methods for navigatinga patient anatomy to conduct a minimally invasive procedure, and moreparticularly to apparatus and methods for guiding and supporting thedelivery of an elongate device (such as a flexible interventionalinstrument and/or a steerable interventional instrument) into a patientanatomy.

BACKGROUND

Minimally invasive medical techniques are intended to reduce the amountof tissue that is damaged during interventional procedures, therebyreducing patient recovery time, discomfort, and harmful side effects.Such minimally invasive techniques may be performed through naturalorifices in a patient anatomy or through one or more surgical incisions.Through these natural orifices or incisions clinicians may insertinterventional instruments (including surgical, diagnostic, therapeutic,or biopsy instruments) to reach a target tissue location. Physicians mayinsert minimally invasive medical instruments (including surgical,diagnostic, therapeutic, or biopsy instruments) through these naturalorifices or incisions to reach a target tissue location. One suchminimally invasive technique is to use a flexible and/or steerableelongate device, such as a flexible catheter, that can be inserted intoanatomic passageways and navigated toward a region of interest withinthe patient anatomy. To reach the target tissue location, a minimallyinvasive interventional instrument may navigate natural or surgicallycreated passageways in anatomical systems such as the lungs, the colon,the intestines, the kidneys, the heart, the circulatory system, or thelike. Control of such an elongate device by medical personnel involvesthe management of several degrees of freedom including at least themanagement of insertion and retraction of the elongate device as well assteering of the device. In addition, different modes of operation mayalso be supported.

Teleoperational interventional systems may be used to insert theflexible interventional instruments into the patient anatomy. Severalinterventional instruments are made of flexible material that allows formaneuverability through a patient's body. In existing systems, at leasta portion of the interventional instrument extending between the patientand a teleoperational manipulator is unsupported, and the flexiblenature of the instrument can cause it to bend, twist, or buckle in anundesirable manner at a point external to the patient's body when forceis exerted to insert the instrument into the patient's anatomy.Deformation of the instrument may damage internal components such asoptical fiber shape sensors or endoscopic equipment. Improved systemsand methods are needed for guiding and supporting interventionalinstruments as they are inserted into a patient anatomy to preventinstrument deformation.

SUMMARY

The embodiments of the invention are summarized by the claims thatfollow the description.

Consistent with some embodiments, An apparatus for guiding an elongatedflexible instrument comprises a variable-length support assembly. Thevariable-length support assembly includes a first end, a second end, aplurality of support member pairs, and a plurality of eyelets configuredto receive the elongated flexible instrument. Each support member paircomprises a first support member linked to a second support member, andeach of the plurality of eyelets is movably coupled to at least one ofthe plurality of support member pairs along a longitudinal central axisbetween the first end and the second end. The variable-length supportassembly is configured to selectively transition from a compressedconfiguration to an expanded configuration along the longitudinalcentral axis, and the plurality of eyelets are adapted to support theelongated flexible instrument as the elongated flexible instrument isadvanced along the longitudinal central axis. Each of the plurality ofeyelets includes a tapered alignment member configured to contact atapered alignment member of an adjacent eyelet to move the plurality ofeyelets into alignment along the longitudinal axis as the variablelength assembly transitions from the expanded configuration to thecompressed configuration.

Consistent with some embodiments, an apparatus for guiding an elongatedflexible instrument comprises a variable-length support assembly. Thevariable-length support assembly includes a first end, a second end, aplurality of support member pairs, and a plurality of eyelets configuredto receive the elongated flexible instrument. Each support member paircomprises a first support member linked to a second support member, andeach of the plurality of eyelets is movably coupled to at least one ofthe support member pairs along a longitudinal central axis between thefirst end and the second end. The apparatus also includes a proximalcoupler at the first end of the variable-length support assembly. Theproximal coupler is configured to couple the variable-length supportassembly to an instrument interface portion, and a proximal armsynchronizing assembly stabilizes a connection between the proximalcoupler and the variable-length support assembly. The variable-lengthsupport assembly is configured to selectively transition from acompressed configuration to an expanded configuration along thelongitudinal central axis. The plurality of eyelets are adapted tosupport the elongated flexible instrument as the elongated flexibleinstrument is advanced along the longitudinal central axis.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory innature and are intended to provide an understanding of the presentdisclosure without limiting the scope of the present disclosure. In thatregard, additional aspects, features, and advantages of the presentdisclosure will be apparent to one skilled in the art from the followingdetailed description.

BRIEF DESCRIPTIONS OF THE DRAWINGS

Aspects of the present disclosure are best understood from the followingdetailed description when read with the accompanying figures. It isemphasized that, in accordance with the standard practice in theindustry, various features are not drawn to scale. In fact, thedimensions of the various features may be arbitrarily increased orreduced for clarity of discussion. In addition, the present disclosuremay repeat reference numerals and/or letters in the various examples.This repetition is for the purpose of simplicity and clarity and doesnot in itself dictate a relationship between the various embodimentsand/or configurations discussed.

FIG. 1 is a simplified diagram of a teleoperated medical systemaccording to some embodiments of the present disclosure.

FIG. 2A is a simplified diagram of a medical instrument system accordingto some embodiments of the present disclosure.

FIG. 2B is a simplified diagram of a medical instrument with an extendedmedical tool according to some embodiments of the present disclosure.

FIG. 3 is a simplified diagram of a side view of a teleoperationalmanipulator assembly, an elongate instrument, and an instrument guidingapparatus according to some embodiments of the present invention.

FIG. 4 illustrates a side view of the instrument guiding apparatus 400in a compressed configuration.

FIG. 5 illustrates a front view of the instrument guiding apparatusshown in FIG. 4.

FIG. 6 illustrates a side view of the instrument guiding apparatus shownin FIG. 4 in an expanded configuration.

FIG. 7 illustrates a top view of the instrument guiding apparatus shownin FIG. 4 in an expanded configuration.

FIG. 8 illustrates a bottom view of the instrument guiding apparatusshown in FIG. 4 in an expanded configuration.

FIG. 9 illustrates a perspective view of the instrument guidingapparatus shown in FIG. 4 in an expanded configuration.

FIGS. 10A-10E illustrate a proximal portion of the variable-lengthsupport assembly shown in FIG. 4. In particular, FIGS. 10A-10Dillustrate perspective views of an exemplary arm synchronizing assemblycoupled to the variable-length support assembly, and FIG. 10Eillustrates a top view of the exemplary arm synchronizing assemblyaccording to one embodiment of the present disclosure.

FIG. 11A illustrates a perspective view of a central portion of thevariable-length support assembly according to one embodiment of thepresent disclosure.

FIGS. 11B-11D illustrate perspective views of a central portion of anexemplary variable-length support assembly according to anotherembodiment of the present disclosure. FIG. 11B illustrates a close-upperspective view of exemplary support members linked by living hinges inan expanded configuration according to one embodiment of the presentdisclosure. FIG. 11C illustrates a perspective view of thevariable-length support assembly in an expanded configuration accordingto one embodiment of the present disclosure. FIG. 11D illustrates aperspective view of the variable-length support assembly in a compressedconfiguration according to one embodiment of the present disclosure.

FIG. 12 illustrates a perspective view of an exemplary first supportmember and an exemplary eyelet according to one embodiment of thepresent disclosure.

FIG. 13 illustrates a perspective view of an exemplary second supportmember according to one embodiment of the present disclosure.

FIG. 14 illustrates a perspective view of the eyelet shown in FIG. 12and exemplary pins according to one embodiment of the presentdisclosure.

FIGS. 15-16B illustrate portions of an exemplary instrument guidingapparatus including exemplary alignment members according to oneembodiment of the present disclosure. In particular, FIG. 15 illustratesa perspective view of an exemplary eyelet, exemplary pins, and exemplaryalignment members. FIG. 16A illustrates a top cutaway view of the eyeletand the alignment members shown in FIG. 15 coupled to a first supportmember and a second support member in an expanded configuration. FIG.16B illustrates a top cutaway view of the eyelet and the alignmentmembers shown in FIG. 15 coupled to the first and second support membersin a compressed configuration.

FIGS. 17-18B illustrate portions of an exemplary instrument guidingapparatus including exemplary alignment members according to anotherembodiment of the present disclosure. In particular, FIG. 17 illustratesa perspective view of an exemplary eyelet and exemplary alignmentmembers. FIG. 18A illustrates a top view of the eyelet and the alignmentmembers shown in FIG. 17 coupled to a first support member and a secondsupport member in an expanded configuration. FIG. 18B illustrates a topview of the eyelet and the alignment members shown in FIG. 17 coupled tothe first and second support members in a partially compressedconfiguration.

FIGS. 19A-19C illustrate perspective views of an exemplary eyelet andexemplary alignment members according to one embodiment of the presentdisclosure.

FIGS. 20A-20D illustrate perspective views of an exemplaryvariable-length support assembly including the eyelet and alignmentmembers shown in FIGS. 19A-19C according to one embodiment of thepresent disclosure.

FIG. 21 illustrates a perspective view of an exemplary eyelet accordingto one embodiment of the present disclosure.

FIGS. 22A-22C illustrate perspective views of an exemplaryvariable-length support assembly including the eyelet shown in FIG. 21according to one embodiment of the present disclosure.

FIG. 23 illustrates a perspective view of an exemplary eyelet accordingto one embodiment of the present disclosure.

FIGS. 24A-24C illustrate perspective views of an exemplaryvariable-length support assembly including the eyelet shown in FIG. 21according to one embodiment of the present disclosure.

FIGS. 25A-25C illustrate perspective views of an exemplaryvariable-length support assembly coupled to exemplary arm synchronizingassemblies according to one embodiment of the present disclosure. FIG.25A illustrates the length of the variable-length support assembly. FIG.25B illustrates an exemplary proximal arm synchronizing assembly coupledto the variable-length support assembly, and FIG. 25C illustrates anexemplary distal arm synchronizing assembly according to one embodimentof the present disclosure.

FIGS. 26A-2B illustrate perspective views of an exemplary instrumentguiding apparatus according to another embodiment of the presentdisclosure.

FIG. 27A illustrates a set of gears in a proximal arm synchronizingassembly according to an embodiment of the present disclosure.

FIG. 27B illustrates a set of gears in a proximal arm synchronizingassembly according to another embodiment of the present disclosure.

FIG. 28 illustrates a cross sectional view of the variable-lengthsupport assembly in a collapsed state.

FIGS. 29A and 29B illustrate perspective and top views, respectively, ofan eyelet according to an embodiment of the present disclosure.

FIGS. 30A and 30B illustrate perspective and top views, respectively, ofan eyelet according to another embodiment of the present disclosure.

FIG. 31A illustrates an assembly fixture for assembly of an instrumentguiding apparatus

FIG. 31B illustrates a single support member 2520 in an explodedconfiguration.

Embodiments of the present disclosure and their advantages are bestunderstood by referring to the detailed description that follows. Itshould be appreciated that like reference numerals are used to identifylike elements illustrated in one or more of the figures, whereinshowings therein are for purposes of illustrating embodiments of thepresent disclosure and not for purposes of limiting the same.

DETAILED DESCRIPTION

In the following description, specific details are set firth describingsome embodiments consistent with the present disclosure. Numerousspecific details are set forth in order to provide a thoroughunderstanding of the embodiments. It will be apparent, however, to oneskilled in the art that some embodiments may be practiced without someor all of these specific details. The specific embodiments disclosedherein are meant to be illustrative but not limiting. One skilled in theart may realize other elements that, although not specifically describedhere, are within the scope and the spirit of this disclosure. Inaddition, to avoid unnecessary repetition, one or more features shownand described in association with one embodiment may be incorporatedinto other embodiments unless specifically described otherwise or if theone or more features would make an embodiment non-functional.

In some instances well known methods, procedures, components, andcircuits have not been described in detail so as not to unnecessarilyobscure aspects of the embodiments.

This disclosure describes various instruments and portions ofinstruments in terms of their state in three-dimensional space. As usedherein, the term “position” refers to the location of an object or aportion of an object in a three-dimensional space (e.g., three degreesof translational freedom along Cartesian x-, y-, and z-coordinates). Asused herein, the term “orientation” refers to the rotational placementof an object or a portion of an object (three degrees of rotationalfreedom e.g., roll, pitch, and yaw). As used herein, the term “pose”refers to the position of an object or a portion of an object in atleast one degree of translational freedom and to the orientation of thatobject or portion of the object in at least one degree of rotationalfreedom (up to six total degrees of freedom). As used herein, the term“shape” refers to a set of poses, positions, or orientations measuredalong an object.

FIG. 1 is a simplified diagram of a teleoperated medical system 100according to some embodiments. In some embodiments, teleoperated medicalsystem 100 may be suitable for use in, for example, surgical,diagnostic, therapeutic, or biopsy procedures. As shown in FIG. 1,medical system 100 generally includes a teleoperational manipulatorassembly 102 for operating a medical instrument 104 in performingvarious procedures on a patient P. Teleoperational manipulator assembly102 is mounted to or near an operating table T. An operator input system106 (sometimes called a master assembly 106) allows an operator asurgeon, a clinician, or a physician O as illustrated in FIG. 1) to viewthe interventional site and to control teleoperational manipulatorassembly 102.

Master assembly 106 may be located at a physician's console which isusually located in the same room as operating table T, such as at theside of a surgical table on which patient P is located. However, itshould be understood that physician O can be located in a different roomor a completely different building from patient P. Master assembly 106generally includes one or more control devices for controllingteleoperational manipulator assembly 102. The control devices mayinclude any number of a variety of input devices, such as joysticks,trackballs, data gloves, trigger-guns, hand-operated controllers, voicerecognition devices, body motion or presence sensors, and/or the like.To provide physician O a strong sense of directly controllinginstruments 104 the control devices may be provided with the samedegrees of freedom as the associated medical instrument 104. In thismanner, the control devices provide physician O with telepresence or theperception that the control devices are integral with medicalinstruments 104.

In some embodiments, the control devices may have more or fewer degreesof freedom than the associated medical instrument 104 and still providephysician O with telepresence. In some embodiments, the control devicesmay optionally be manual input devices which move with six degrees offreedom, and which may also include an actuatable handle for actuatinginstruments (for example, for closing grasping jaws, applying anelectrical potential to an electrode, delivering a medicinal treatment,and/or the like).

FIG. 1 is a simplified diagram of a teleoperated medical system 100according to some embodiments. In some embodiments, teleoperated medicalsystem 100 may be suitable for use in, for example, surgical,diagnostic, therapeutic, or biopsy procedures. As shown in FIG. 1, theteleoperated system 100 generally includes a teleoperational manipulatorassembly 102 for operating a medical instrument 104 in performingvarious procedures on the patient P. The assembly 102 is mounted to ornear an operating table O. A master assembly 106 allows an operator(e.g., a surgeon, a clinician, or a physician O as illustrated inFIG. 1) to view the interventional site and to control theteleoperational manipulator assembly 102.

The master assembly 106 (or master surgeon control inputs assembly 106)may be located at a surgeon's console which is usually located in thesame room as operating table O. However, it should be understood thatthe physician O can be located in a different room or a completelydifferent building from the patient P. Master assembly 106 generallyincludes one or more control devices for controlling the manipulatorassemblies 102. The control devices may include any number of a varietyof input devices, such as joysticks, trackballs, data gloves,trigger-guns, hand-operated controllers, voice recognition devices, bodymotion or presence sensors, or the like. To provide physician O a strongsense of directly controlling instruments 104 the control devices may beprovided with the same degrees of freedom as the associated medicalinstrument 104. In this manner, the control devices provide physician Owith telepresence or the perception that the control devices areintegral with medical instruments 104.

In some embodiments, the control devices may have more or fewer degreesof freedom than the associated medical instruments 104 and still providethe physician O with telepresence. In some embodiments, the controldevices are manual input devices which move with six degrees of freedom,and which may also include an actuatable handle for actuatinginstruments (for example, for closing grasping jaws, applying anelectrical potential to an electrode, delivering a medicinal treatment,or the like).

The teleoperational assembly 102 supports the medical instrument system104 and may include a kinematic structure of one or more non-servocontrolled links (e.g., one or more links that may be manuallypositioned and locked in place, generally referred to as a set-upstructure) and a teleoperational manipulator. The teleoperationalassembly 102 includes plurality of actuators or motors that drive inputson the medical instrument system 104 in response to commands from thecontrol system (e.g., a control system 112). The motors include drivesystems that when coupled to the medical instrument system 104 mayadvance the medical instrument into a naturally or surgically createdanatomic orifice. Other motorized drive systems may move the distal endof the medical instrument in multiple degrees of freedom, which mayinclude three degrees of linear motion (e.g., linear motion along the X,Y, Z Cartesian axes) and in three degrees of rotational motion (e.g.,rotation about the X, Y, Z Cartesian axes). Additionally, the motors canbe used to actuate an articulable end effector of the instrument forgrasping tissue in the jaws of a biopsy device or the like. Motorposition sensors such as resolvers, encoders, potentiometers, and othermechanisms may provide sensor data to the teleoperational assemblydescribing the rotation and orientation of the motor shafts. Thisposition sensor data may be used to determine motion of the objectsmanipulated by the motors.

The teleoperational medical system 100 also includes a sensor system 108with one or more sub-systems for receiving information about theinstruments of the teleoperational assembly. Such sub-systems mayinclude a position/location sensor system (e.g., an electromagnetic (EM)sensor system); a shape sensor system for determining the position,orientation, speed, velocity, pose, and/or shape of the catheter tipand/or of one or more segments along a flexible body of instrumentsystem 104; and/or a visualization system for capturing images from thedistal end of the catheter system.

The visualization system (e.g., visualization system 231 of FIG. 2A) mayinclude a viewing scope assembly that records a concurrent or real-timeimage of the surgical site and provides the image to the clinician orsurgeon S. The concurrent image may be, for example, a two or threedimensional image captured by an endoscope positioned within thesurgical site. In this embodiment, the visualization system includesendoscopic components that may be integrally or removably coupled to themedical instrument 104. However in alternative embodiments, a separateendoscope, attached to a separate manipulator assembly may be used withthe medical instrument to image the surgical site. The visualizationsystem may be implemented as hardware, firmware, software or acombination thereof which interact with or are otherwise executed by oneor more computer processors, which may include the processors of acontrol system 112 (described below). The processors of the controlsystem 112 may execute instructions comprising instruction correspondingto processes disclosed herein.

The teleoperational medical system 100 also includes a display system110 for displaying an image or representation of the surgical site andmedical instrument system(s) 104 generated by sub-systems of the sensorsystem 108. The display system 110 and the operator input system 106 maybe oriented so the physician O can control the medical instrument system104 and the operator input system 106 with the perception oftelepresence.

The display system 110 may also display an image of the surgical siteand medical instruments captured by the visualization system. Thedisplay system 110 and the control devices may be oriented such that therelative positions of the imaging device in the scope assembly and themedical instruments are similar to the relative positions of thesurgeon's eyes and hands so the operator can manipulate the medicalinstrument 104 and the hand control as if viewing the workspace insubstantially true presence. By true presence, it is meant that thepresentation of an image is a true perspective image simulating theviewpoint of an operator that is physically manipulating the instrument104.

Alternatively or additionally, the display system 110 may present imagesof the surgical site recorded pre-operatively or intra-operatively usingimage data from imaging technology such as, computed tomography (CT),magnetic resonance imaging (MRI), fluoroscopy, thermography, ultrasound,optical coherence tomography (OCT), thermal imaging, impedance imaging,laser imaging, or nanotube X-ray imaging. The pre-operative orintra-operative image data may be presented as two-dimensional,three-dimensional, or four-dimensional (including e.g., time based orvelocity based information) images or as images from models created fromthe pre-operative or intra-operative image data sets.

In some embodiments, often for purposes of imaged guided surgicalprocedures, the display system 110 may display a virtual navigationalimage in which the actual location of the medical instrument 104 isregistered (i.e., dynamically referenced) with the preoperative orconcurrent images/model to present the physician O with a virtual imageof the internal surgical site from the viewpoint of the location of thetip of the instrument 104. In some examples, the viewpoint may be from atip of medical instrument 104. An image of the tip of the instrument 104or other graphical or alphanumeric indicators may be superimposed on thevirtual image to assist the physician O controlling the medicalinstrument. Alternatively, the instrument 104 may not be visible in thevirtual image.

In other embodiments, the display system 110 may display a virtualnavigational image in which the actual location of the medicalinstrument is registered with preoperative or concurrent images topresent the physician O with a virtual image of medical instrumentwithin the surgical site from an external viewpoint. An image of aportion of the medical instrument or other graphical or alphanumericindicators may be superimposed on the virtual image to assist thephysician O controlling the instrument 104. As described herein, visualrepresentations of data points may be rendered to the display system110. For example, measured data points, moved data points, registereddata points, and other data points described herein may be displayed onthe display system 110 in a visual representation. The data points maybe visually represented in a user interface by a plurality of points ordots on the display or as a rendered model, such as a mesh or wire modelcreated based on the set of data points. In some embodiments, a visualrepresentation may be refreshed in the display system 110 after eachprocessing operations has been implemented to alter the data points.

The teleoperational medical system 100 also includes a control system112. The control system 112 includes at least one memory and at leastone computer processor (not shown), and typically a plurality ofprocessors, for effecting control between the medical instrument system104, the operator input system 106, the sensor system 108, and thedisplay system 110. The control system 112 also includes programmedinstructions (e.g., a non-transitory machine-readable medium storing theinstructions) to implement some or all of the methods described inaccordance with aspects disclosed herein, including instructions forproviding pathological information to the display system 110. Whilecontrol system 112 is shown as a single block in the simplifiedschematic of FIG. 1, the system may include two or more data processingcircuits with one portion of the processing optionally being performedon or adjacent the teleoperational assembly 102, another portion of theprocessing being performed at the operator input system 106, anotherportion of the processing being performed at master assembly 106, andthe like. The processors of control system 112 may execute instructionscomprising instruction corresponding to processes disclosed herein anddescribed in more detail below. Any of a wide variety of centralized ordistributed data processing architectures may be employed. Similarly,the programmed instructions may be implemented as a number of separateprograms or subroutines, or they may be integrated into a number ofother aspects of the teleoperational systems described herein. In oneembodiment, control system 112 supports wireless communication protocolssuch as Bluetooth, IrDA, HomeRF, IEEE 802.11, DECT, and WirelessTelemetry.

In some embodiments, control system 112 may receive force and/or torquefeedback from medical instrument 104. Responsive to the feedback,control system 112 may transmit signals to master assembly 106. In someexamples, control system 112 may transmit signals instructing one ormore actuators of teleoperational manipulator assembly 102 to movemedical instrument 104. Medical instrument 104 may extend into aninternal surgical site within the body of patient P via openings in thebody of patient P. Any suitable conventional and/or specializedactuators may be used. In some examples, the one or more actuators maybe separate from, or integrated with, teleoperational manipulatorassembly 102. In some embodiments, the one or more actuators andteleoperational manipulator assembly 102 are provided as part of ateleoperational cart positioned adjacent to patient P and operatingtable T.

The control system 112 may further include a virtual visualizationsystem to provide navigation assistance to physician O when controllingthe medical instrument system(s) 104 during an image-guided surgicalprocedure. Virtual navigation using the virtual visualization system isbased upon reference to the acquired preoperative or intraoperativedataset of the anatomic passageways. The virtual visualization systemprocesses images of the surgical site imaged using imaging technologysuch as computerized tomography (CT), magnetic resonance imaging (MRI),fluoroscopy, thermography, ultrasound, optical coherence tomography(OCT), thermal imaging, impedance imaging, laser imaging, nanotube X-rayimaging, or the like. Software, which may be used in combination withmanual inputs, is used to convert the recorded images into segmented twodimensional or three dimensional composite representation of a partialor an entire anatomic organ or anatomic region. An image data set isassociated with the composite representation. The compositerepresentation and the image data set describe the various locations andshapes of the passageways and their connectivity. The images used togenerate the composite representation may be recorded preoperatively orintra-operatively during a clinical procedure. In some embodiments, avirtual visualization system may use standard representations (i.e., notpatient specific) or hybrids of a standard representation and patientspecific data. The composite representation and any virtual imagesgenerated by the composite representation may represent the staticposture of a deformable anatomic region during one or more phases ofmotion (e.g., during an inspiration/expiration cycle of a lung).

During a virtual navigation procedure, the sensor system 108 may be usedto compute an approximate location of the instrument with respect to theanatomy of patient P. The location can be used to produce bothmacro-level (external) tracking images of the anatomy of patient P andvirtual internal images of the anatomy of patient P. The system mayimplement one or more electromagnetic (EM) sensor, fiber optic sensors,and/or other sensors to register and display a medical implementtogether with preoperatively recorded surgical images, such as thosefrom a virtual visualization system. For example U.S. patent applicationSer. No. 13/107,562 (filed May 13, 2011) (disclosing “Medical SystemProviding Dynamic Registration of a Model of an Anatomic Structure forImage-Guided Surgery”) which is incorporated by reference herein in itsentirety, discloses one such system.

The teleoperational medical system 100 may further include optionaloperation and support systems (not shown) such as illumination systems,steering control systems, irrigation systems, and/or suction systems. Insome embodiments, the teleoperational system may include more than oneteleoperational assembly and/or more than one master assembly. The exactnumber of manipulator assemblies will depend on the surgical procedureand the space constraints within the operating room, among otherfactors. Master assembly 106 may be collocated or they may be positionedin separate locations. Multiple master assemblies allow more than oneoperator to control one or more teleoperational manipulator assembliesin various combinations.

FIG. 2A is a simplified diagram of a medical instrument system 200according to some embodiments. In some embodiments, medical instrumentsystem 200 may be used as medical instrument 104 in an image-guidedmedical procedure performed with teleoperated medical system 100. Insome examples, medical instrument system 200 may be used fornon-teleoperational exploratory procedures or in procedures involvingtraditional manually operated medical instruments, such as endoscopy.Optionally medical instrument system 200 may be used to gather (i.e.,measure) a set of data points corresponding to locations within anatomicpassageways of a patient, such as patient P.

The instrument system 200 includes an elongate device 202 (e.g., acatheter system) coupled to a drive unit 204. The elongate device 202includes an elongated flexible body 216 having a proximal end 217 and adistal end 218 (or tip portion 218). In one embodiment, the flexiblebody 216 has an approximately 3 mm outer diameter. Other flexible bodyouter diameters may be larger or smaller.

Medical instrument system 200 further includes a tracking system 230 fordetermining the position, orientation, speed, velocity, pose, and/orshape of distal end 218 and/or of one or more segments 224 alongflexible body 216 using one or more sensors and/or imaging devices asdescribed in further detail below. The entire length of flexible body216, between distal end 218 and proximal end 217, may be effectivelydivided into segments 224. If medical instrument system 200 isconsistent with medical instrument 104 of a teleoperated medical system100, tracking system 230. Tracking system 230 may optionally beimplemented as hardware, firmware, software or a combination thereofwhich interact with or are otherwise executed by one or more computerprocessors, which may include the processors of control system 112 inFIG. 1.

Tracking system 230 may optionally track distal end 218 and/or one ormore of the segments 224 using a shape sensor 222. Shape sensor 222 mayoptionally include an optical fiber aligned with flexible body 216(e.g., provided within an interior channel (not shown) or mountedexternally). In one embodiment, the optical fiber has a diameter ofapproximately 200 μm. In other embodiments, the dimensions may be largeror smaller. The optical fiber of shape sensor 222 forms a fiber opticbend sensor for determining the shape of flexible body 216. In onealternative, optical fibers including Fiber Bragg Gratings (FBGs) areused to provide strain measurements in structures in one or moredimensions. Various systems and methods for monitoring the shape andrelative position of an optical fiber in three dimensions are describedin U.S. patent application Ser. No. 11/180,389 (filed Jul. 13, 2005)(disclosing “Fiber optic position and shape sensing device and methodrelating thereto”); U.S. patent application Ser. No. 12/047,056 (filedon Jul. 16, 2004) (disclosing “Fiber-optic shape and relative positionsensing”); and U.S. Pat. No. 6,389,187 (filed on Jun. 17, 1998)(disclosing “Optical Fibre Bend Sensor”), which are all incorporated byreference herein in their entireties. Sensors in some embodiments mayemploy other suitable strain sensing techniques, such as Rayleighscattering, Raman scattering, Brillouin scattering, and Fluorescencescattering. In some embodiments, the shape of the elongate device may bedetermined using other techniques. For example, a history of the distalend pose of flexible body 216 can be used to reconstruct the shape offlexible body 216 over the interval of time. In some embodiments,tracking system 230 may optionally and/or additionally track distal end218 using a position sensor system 220. Position sensor system 220 mayuse any appropriate sensing technology or combination of sensingtechnologies, such as: OFDR (optical frequency domain reflectometry)techniques such as those using Fiber Bragg gratings, Raleigh scattering,or some other applicable reflection approach; position sensors enabledby EM (electromagnetic) techniques; linear rotary encoder techniquessupported by capacitive, optical, resistive, or other technologies; etc.As a specific example, position sensor system 220 may comprise of, or bea component of, an EM sensor system with positional sensor system 220including one or more conductive coils that may be subjected to anexternally generated electromagnetic field. Each coil of such an EMsensor system used to implement position sensor system 220 then producesan induced electrical signal having characteristics that depend on theposition and orientation of the coil relative to the externallygenerated electromagnetic field. In some embodiments, position sensorsystem 220 may be configured and positioned to measure six degrees offreedom, e.g., three position coordinates X, Y, Z and three orientationangles indicating pitch, yaw, and roll of a base point or five degreesof freedom, e.g., three position coordinates X, Y, Z and two orientationangles indicating pitch and yaw of a base point. Further description ofa position sensor system is provided in U.S. Pat. No. 6,380,732 (filedAug. 11, 1999) (disclosing “Six-Degree of Freedom Tracking System Havinga Passive Transponder on the Object Being Tracked”), which isincorporated by reference herein in its entirety.

In some embodiments, tracking system 230 may alternately and/oradditionally rely on historical pose, position, or orientation datastored for a known point of an instrument system along a cycle ofalternating motion, such as breathing. This stored data may be used todevelop shape information about flexible body 216. In some examples, aseries of positional sensors (not shown), such as electromagnetic (EM)sensors similar to the sensors used in some embodiments of positionsensor system 220 may be positioned along flexible body 216 and thenused for shape sensing. In some examples, a history of data from one ormore of these sensors taken during a procedure may be used to representthe shape of elongate device 202, particularly if an anatomic passagewayis generally static.

Flexible body 216 includes a channel 221 sized and shaped to receive amedical instrument 226. FIG. 2B is a simplified diagram of flexible body216 with medical instrument 226 extended according to some embodiments.In some embodiments, medical instrument 226 may be used for proceduressuch as surgery, biopsy, ablation, illumination, irrigation, or suction.Medical instrument 226 can be deployed through channel 221 of flexiblebody 216 and used at a target location within the anatomy. Medicalinstrument 226 may include, for example, image capture probes, biopsyinstruments, laser ablation fibers, and/or other surgical, diagnostic,or therapeutic tools. Medical tools may include end effectors having asingle working member such as a scalpel, a blunt blade, an opticalfiber, an electrode, and/or the like. Other end effectors may include,for example, forceps, graspers, scissors, clip appliers, and/or thelike. Other end effectors may further include electrically activated endeffectors such as electrosurgical electrodes, transducers, sensors,and/or the like. In various embodiments, medical instrument 226 is abiopsy instrument, which may be used to remove sample tissue or asampling of cells from a target anatomic location. Medical instrument226 may be used with an image capture probe also within flexible body216. In various embodiments, medical instrument 226 may be an imagecapture probe that includes a distal portion with a stereoscopic ormonoscopic camera at or near distal end 218 of flexible body 216 forcapturing images (including video images) that are processed by avisualization system 231 for display and/or provided to tracking system230 to support tracking of distal end 218 and/or one or more of thesegments 224. The image capture probe may include a cable coupled to thecamera for transmitting the captured image data. In some examples, theimage capture instrument may be a fiber-optic bundle, such as afiberscope, that couples to visualization system 231. The image captureinstrument may be single or multi-spectral, for example capturing imagedata in one or more of the visible, infrared, and/or ultravioletspectrums. Alternatively, medical instrument 226 may itself be the imagecapture probe. Medical instrument 226 may be advanced from the openingof channel 221 to perform the procedure and then retracted back into thechannel when the procedure is complete. Medical instrument 226 may beremoved from proximal end 217 of flexible body 216 or from anotheroptional instrument port (not shown) along flexible body 216.

Medical instalment 226 may additionally house cables, linkages, or otheractuation controls (not shown) that extend between its proximal anddistal ends to controllably the bend distal end of medical instrument226. Steerable instruments are described in detail in U.S. Pat. No.7,316,681 (filed on Oct. 4, 2005) (disclosing “Articulated SurgicalInstrument for Performing Minimally Invasive Surgery with EnhancedDexterity and Sensitivity”) and U.S. patent application Ser. No.12/286,644 (filed Sep. 30, 2008) (disclosing “Passive Preload andCapstan Drive for Surgical Instruments”), which are incorporated byreference herein in their entireties.

Flexible body 216 may also house cables, linkages, or other steeringcontrols (not shown) that extend between drive unit 204 and distal end218 to controllably bend distal end 218 as shown, for example, by brokendashed line depictions 219 of distal end 218. In some examples, at leastfour cables are used to provide independent “up-down” steering tocontrol a pitch of distal end 218 and “left-right” steering to control ayaw of distal end 281. Steerable elongate devices are described indetail in U.S. patent application Ser. No. 13/274,208 (filed Oct. 14,2011) (disclosing “Catheter with Removable Vision Probe”), which isincorporated by reference herein in its entirety. In embodiments inwhich medical instrument system 200 is actuated by a teleoperationalassembly, drive unit 204 may include drive inputs that removably coupleto and receive power from drive elements, such as actuators, of theteleoperational assembly. In some embodiments, medical instrument system200 may include gripping features, manual actuators, or other componentsfor manually controlling the motion of medical instrument system 200.Elongate device 202 may be steerable or, alternatively, the system maybe non-steerable with no integrated mechanism for operator control ofthe bending of distal end 218. In some examples, one or more lumens,through which medical instruments can be deployed and used at a targetsurgical location, are defined in the walls of flexible body 216.

In some embodiments, medical instrument system 200 may include aflexible bronchial instrument, such as a bronchoscope or bronchialcatheter, for use in examination, diagnosis, biopsy, or treatment of alung. Medical instrument system 200 is also suited for navigation andtreatment of other tissues, via natural or surgically created connectedpassageways, in any of a variety of anatomic systems, including thecolon, the intestines, the kidneys and kidney calices, the brain, theheart, the circulatory system including vasculature, and/or the like.

The information from tracking system 230 may be sent to a navigationsystem 232 where it is combined with information from visualizationsystem 231 and/or the preoperatively obtained models to provide thephysician or other operator with real-time position information. In someexamples, the real-time position information may be displayed on displaysystem 110 of FIG. 1 for use in the control of medical instrument system200. In some examples, control system 116 of FIG. 1 may utilize theposition information as feedback for positioning medical instrumentsystem 200. Various systems for using fiber optic sensors to registerand display a surgical instrument with surgical images are provided inU.S. patent application Ser. No. 13/107,562, filed May 13, 2011,disclosing, “Medical System Providing Dynamic Registration of a Model ofan Anatomic Structure for Image-Guided Surgery,” which is incorporatedby reference herein in its entirety.

In some examples, medical instrument system 200 may be teleoperatedwithin medical system 100 of FIG. 1. In some embodiments,teleoperational manipulator assembly 102 of FIG. 1 may be replaced bydirect operator control. In some examples, the direct operator controlmay include various handles and operator interfaces for hand-heldoperation of the instrument.

When using a teleoperational assembly to insert a catheter (or otherelongate, flexible medical instrument) into a patient anatomy, thecatheter length external to the patient should be supported as it isadvanced into the patient. Otherwise, as the catheter is pushed from aproximal end and encounters friction in the patient anatomy at thedistal end, the catheter may buckle or bend. To prevent this deformationof the catheter, an instrument guiding apparatus may be used to providesupport to the catheter at regular intervals as it enters the patientanatomy along an insertion axis. The catheter may be threaded intochannels or eyelets of the instrument guiding apparatus before thecatheter is introduced into the patient's anatomy. In the embodimentsdescribed herein, the instrument guiding apparatus can transitionbetween a compressed configuration and an expanded configuration. Inembodiments described herein, the guiding apparatus includes alignmentelements that enable the eyelets of the guiding apparatus to self-alignalong the insertion axis before the catheter is introduced into theguiding apparatus. Generally, the catheter is introduced into theguiding apparatus while the apparatus is in a compressed configuration.After a distal portion of the catheter is threaded through the eyeletsof the guiding apparatus, the guiding apparatus can be expanded aboutthe remainder of the catheter. The instrument guiding apparatus returnsto a compressed configuration as the catheter is advanced into thepatient anatomy and the exposed length of the catheter decreases. As thecatheter enters the patient anatomy, the guiding apparatus compressesand the alignment members guide the eyelets to realign with theinsertion axis. In some embodiments, the instrument guiding apparatusdescribed herein includes features that increase the rigidity andstability of the apparatus in an expanded configuration. Thus, theembodiments described herein effectively provide stable support to thecatheter as it is introduced into, traverses through, and is removedfrom the patient anatomy.

FIG. 3 diagrammatically illustrates an instrument interface portion 300of a teleoperational manipulator assembly (e.g., teleoperationalmanipulator assembly 102) and an instrument guiding apparatus 302according to an embodiment of the present invention. The instrumentinterface portion 300 includes drive inputs 304 that may providemechanical coupling of the instrument end effector and flexible bodysteering mechanism to the drive motors mounted to the teleoperationalmanipulator. For example, a pair of drive inputs may control the pitchmotion of the distal end of the instrument flexible body, with oneadaptor of the pair controlling motion in the upward direction and theother of the pair controlling motion in the opposite downward direction.Other pairs of drive inputs may provide opposing motion in other degreesof freedom for the flexible body and/or the end effector. In someembodiments, the drive inputs 304 may be coupled to or positioned withinan instrument control unit 305, which controls the positioning of anelongate instrument such as a catheter 310 Instrument interfacing withteleoperational or robotic manipulators is described, for example inU.S. Pat. No. 6,331,181, filed Oct. 15, 1999, disclosing “SurgicalRobotic Tools, Data Architecture, And Use” and U.S. Pat. No. 6,491,701,filed Jan. 12, 2001 disclosing “Mechanical Actuator Interface System ForRobotic Surgical Tools” which are both incorporated by reference hereinin their entirety. The instrument interface portion 300 may also controlinstrument insertion by moving linearly along an insertion axis A.

During use, the catheter 310 is positioned within the instrument guidingapparatus 302 and the instrument guiding apparatus 302 acts to minimizethe buckling of the catheter 310 as the catheter 310 advances toward,remains within, and retracts from the patient anatomy. The instrumentguiding apparatus 302 has a proximal end 312 and a distal end 314. Insome embodiments, the proximal end 312 of the instrument guidingapparatus 302 is detachably coupled to a mounting plate 316 of theinstrument interface portion 300. The mounting plate 316 may be moveable(e.g., along the insertion axis A) relative to a proximal end 318 and adistal end 320 of the instrument interface portion 300. The proximal end318 and the distal end 320 may or may not be disposed at the physicalends of the instrument interface portion 300. For example, in thepictured embodiment, the proximal end 318 and the distal end 320comprise motion stops disposed away from the actual ends of theinstrument interface portion 300 that are shaped and configured to haltthe axial translation of the mounting plate 316. During use, the distalend 314 of the instrument guiding apparatus 302 may be detachablycoupled to an anchor 317 within the surgical field. The anchor 317 maybe positioned on the instrument interface portion 300 (e.g., on aflexible instrument manipulator or FIM), the surgical table, on asurgical frame, or on the patient anatomy. In one example, the anchor317 may comprise a mouth guard clamped by patient's teeth. Theinstrument guiding apparatus 302 provides longitudinal support along thelength of the catheter 310 positioned within the instrument guidingapparatus 302 to minimize buckling of the exposed length of the catheter310 as it is pushed into the patient's body P.

FIGS. 4-9 illustrate various views of an exemplary instrument guidingapparatus 400 according to one embodiment of the present disclosure. Inparticular, FIG. 4 illustrates a side view of the instrument guidingapparatus 400 in a compressed configuration. FIG. 5 illustrates a frontview of the instrument guiding apparatus 400. FIG. 6 illustrates a sideview of the instrument guiding apparatus 400 in an expandedconfiguration. FIG. 7 illustrates a top view of the instrument guidingapparatus 400 in an expanded configuration. FIG. 8 illustrates a bottomview of the instrument guiding apparatus 400 in an expandedconfiguration. FIG. 9 illustrates a perspective view of the instrumentguiding apparatus 400 in an expanded configuration.

The instrument guiding apparatus 400 is a particular example of theinstrument guiding apparatus 302 shown in FIG. 3. The design, function,and use of this specific embodiment are the same as described withreference to the instrument guiding apparatus 302 shown in FIG. 3 unlessotherwise noted or apparent from the description. In the picturedembodiment, the instrument guiding apparatus 400 includes a proximalcoupler 405, a variable-length support assembly 410 extending from afirst end 412 to a distal end 414, a distal coupler 415 at the distalend 414, and a retaining assembly 420 such as a latch mechanism. In use,the catheter 310 may be threaded through a proximal aperture 422 (shownin FIG. 10A) on the proximal coupler 405, through the variable-lengthsupport assembly 410, and through a distal aperture 425 (shown in FIG.5). The proximal aperture 422 may also be referred to as lumen 422.Initially, in some instances, the instrument guiding apparatus 400 canshift from the compressed configuration shown in FIG. 4 into theexpanded configuration shown in FIGS. 6-9 after the catheter 310 isthreaded distally through the variable-length support assembly 410.After the catheter 310 travels through the variable-length supportassembly 410 and enters the patient, the instrument guiding apparatus400 can shift from the expanded or extended configuration shown in FIGS.6-9 to the compressed configuration shown in FIG. 4 into the as thecatheter 310 is advanced distally into the patient along the insertionaxis A. The instrument guiding apparatus 400 and the variable-lengthsupport assembly 410 extend as the catheter 310 is withdrawn from thepatient and a longer length of catheter 310 is exposed outside thepatient (i.e., the exposed of length of catheter 310 in need ofsupport).

The proximal coupler 405 detachably couples the first end 412 of thevariable-length support assembly 410 to the instrument interface portion300 and/or the instrument control unit 305 via fastening elements 430 aand 430 b (shown in FIG. 7). In the pictured embodiment, the fasteningelements 430 a, 430 b comprise shoulder screws or shoulder bolts thatare shaped and sized to mate with corresponding threaded holes withinthe instrument interface portion 300 (e.g., on the mounting plate 316)and/or the instrument control unit 305 shown in FIG. 3. As shown in FIG.8, the proximal coupler 405 includes threaded holes 435 a, 435 b, whichare shaped and sized to receive the fastening elements 430 a, 430 b,respectively. After aligning the threaded holes 435 a, 435 b with thecorresponding threaded holes in the instrument interface portion 300and/or the instrument control unit 305, the fastening elements 430 a,430 b may be inserted through the threaded holes 435 a, 435 b,respectively, and tightened to securely attach the instrument guidingapparatus 400 to the mounting plate 316 (or another part of theinstrument interface portion 300 shown in FIG. 3). Other embodiments mayinclude any of a variety of fastening elements capable of securely yetdetachably coupling the proximal coupler 405 of the instrument guidingapparatus 400 to the teleoperational manipulator assembly, including,without limitation, snap-fit engagements, frictional engagements,hook-and-eye fasteners, pins, carriage bolts, and mating screws. Theproximal coupler 405 includes a lumen 422 (shown in FIGS. 9 and 10A)that is sized and shaped to receive the catheter 310 (or other elongatemember) into the instrument guiding apparatus 400. In some embodiments,the lumen 422 is linearly aligned with the distal aperture 425 in thedistal coupler 415 along the insertion axis A.

As shown in FIG. 4, when the instrument guiding apparatus 400 iscollapsed, the retaining assembly 420 may be used to selectively retainthe variable-length support assembly 410 in the compressedconfiguration. In the pictured embodiment, the retaining assembly 420comprises a hinged mechanism including a proximal section 440 and adistal section 445. The proximal section 440 is hingedly coupled to theproximal coupler 405 at one end and is hingedly coupled to the distalsection 445 at the opposite end. The distal section 445 includes adistal fastener 448 shaped and sized to selectively engage an attachmentelement 450 disposed on the distal coupler 415. In the picturedembodiment, as shown in FIGS. 4 and 5, the distal fastener 448 is shapedas an indented hook sized to selectively latch onto the attachmentelement 450, which is shaped as a bar. In particular, the attachmentelement 450 is configured to snap into a corresponding indentation 455on the distal fastener 448. In other embodiments, the distal fastener448 and the attachment element 450 are shaped and sized as any of avariety of detachably mating fastening elements, including, withoutlimitation, other snap-fit engagements, hook and eye fasteners, threadedengagements, and frictional engagements. In some instances, when theinstrument guiding apparatus 400 is being transported or is beingattached to the teleoperational manipulator assembly 102, or when thecatheter 310 is being initially threaded through the instrument guidingapparatus 400, the retaining assembly 420 may be used to temporarilylock the variable-length support assembly 410 in the compressedconfiguration shown in FIG. 4. When the distal fastener 448 is detachedfrom the attachment element 450, the distal section 445 can fold towardsthe proximal section 440, and both these sections 445, 440 can lift awayfrom the variable-length support assembly 410 and fold in the directionof the arrow A1. After detaching the distal fastener 448 from theattachment element 450, the variable-length support assembly 410 is ableto stretch into an expanded configuration, as shown in FIGS. 6-9.

In addition to cooperating with the retaining assembly 420 to retain theinstrument guiding apparatus 400 in a compressed configuration, thedistal coupler 415 may be used to detachably couple the instrumentguiding apparatus 400 to the patient or another device (e.g., astabilizer mounted to the patient or the surgical table) to stabilizethe distal end of the instrument guiding apparatus as the catheter 310is passed through the variable-length support assembly 410. For example,in some embodiments, the attachment element 450 of the distal coupler415 may be connected to a stabilizer, such as, by way of non-limitingexample, a hook or a tether, in the surgical field. During use, thestabilizer may be connected to the patient's body and/or the surgicaltable. In some instances, the stabilizer may comprise an introducersheath at the insertion site configured to receive the catheter 310. Theinstrument guiding apparatus 400 provides support at discrete intervalsalong the length of the catheter 310 between the stabilizer and theproximal coupler 405. In general, the distal coupler 415 is stationarywith respect to the patient.

The variable-length support assembly 410 can expand from the compressedconfiguration shown in FIG. 4 into the expanded configuration shown inFIGS. 6-9 as the proximal coupler 405 moves proximally in the directionof arrow A1 along the insertion axis A. In some instances, motion of thecatheter 310 in and out of the patient anatomy is coupled to the motionof the proximal coupler 405. In some instances, the proximal coupler 405moves in the direction of the arrow A2 in concert with the catheter 310as the catheter 310 is initially advanced distally along the insertionaxis A and into the patient anatomy. Similarly, in some instances, theproximal coupler 405 moves in the direction of the arrow A1 along theinsertion axis A in concert with the catheter 310 as the catheter 310 isremoved from the patient anatomy. The variable-length support assembly410 may collapse or fold back into a compressed configuration as theinstrument interface portion 300 and/or the instrument control unit 305shown in FIG. 3 advances the catheter 310 further into the patientanatomy, thereby linearly displacing the variable-length supportassembly 410 in the direction of arrow A2 along the axis A. When thecatheter 310 is fully inserted into the patient, the variable-lengthsupport assembly 410 is in a compressed condition as illustrated in FIG.4. When the catheter 310 is only partially inserted into the patient,the variable-length support assembly 410 is partially extended as shownin FIGS. 6-9. When the catheter 310 is fully withdrawn from the patientor at least retracted (e.g., into a delivery instrument) out of directcontact with patient anatomy, the variable-length support assembly 410is fully extended.

As shown in FIG. 4, the variable-length support assembly 410 is disposedbetween the proximal coupler 405 and the distal coupler 415. As shown inFIGS. 6-9, the variable-length support assembly 410 includes multiplepairs of corresponding support members 460, 465 connected to each otherto create an expandable scaffolding structure. The first support members460 are coupled to the second support members 465 to create a supportframe of pairs of support members 460, 465 assembled in an expandablescissor-like configuration. As shown in FIG. 7, when the instrumentguiding apparatus 400 is in an expanded configuration, the first supportmembers 460 interlace with the second support members 465 along acentral axis CA to form the variable-length support assembly 410. Thefirst support members 460 extend through and generally bisect the secondsupport members 465 to form the crisscrossed, expandable variable-lengthsupport assembly 410.

FIGS. 10A-10D illustrate perspective views of a proximal portion of thevariable-length support assembly 410 and the proximal coupler 405according to one embodiment of the present disclosure. FIG. 10Eillustrates a top view of a proximal portion of the variable-lengthsupport assembly 410 according to one embodiment of the presentdisclosure. FIG. 11A illustrates a perspective view of a central portionof the variable-length support assembly 410 according to one embodimentof the present disclosure. As shown by FIGS. 7, 8, and 11A, thevariable-length support assembly 410 includes two proximal arms 470 a,470 b, two distal arms 472 a, 472 b, and a repeating array of three maincomponents: the first support member 460, the second support member 465,and an eyelet 475. FIG. 12 illustrates a perspective view of the firstsupport member 460 and the eyelet 475 one embodiment of the presentdisclosure. FIG. 13 illustrates a perspective view of the second supportmember 465 one embodiment of the present disclosure. FIG. 14 illustratesa perspective view of the eyelet 475 according to one embodiment of thepresent disclosure.

As shown in FIG. 14, each eyelet 475 comprises a generally hollowcylinder or annular ring. In other embodiments, the eyelet 475 maycomprise any of a variety of passageways with a variety of sizes andshapes. For example, some embodiments may include a rectangular or ovoideyelet. The eyelets 475 are configured to receive pins or other securingelements in receiving holes 476 a, 476 b, which are positioned onopposite sides of an external surface 477 of the eyelet 475. In use, theeyelets 475 are configured to receive an elongate instrument, such as,without limitation, the catheter 310, a sheath, a guidewire, or anycombination thereof. In the pictured embodiment, the eyelets 475 aresized and shaped to permit the easy passage of the catheter 310therethrough. As shown in FIG. 14, the eyelet 475 includes a lumen 478that has a diameter D1 that is sized to accommodate the catheter 310.The diameter D1 may range from 2 mm to 12 mm. In some embodiments, thediameter D1 measures 5 mm. Other diameters are contemplated. As shown inFIG. 12, the first support member 460 includes a central opening 480that has a diameter D2 that is sized to accommodate a single eyelet 475.The diameter D2 may range from 4 mm to 24 mm. In some embodiments, thediameter D2 measures 10 mm. Other diameters are contemplated. The eyelet475 has a thickness T1, and the central opening 480 of the first supportmember 460 has a central thickness T2 and an outer thickness T3. In thepictured embodiment, the thickness T1 of the eyelet 475 is approximatelythe same as the central thickness T2. In other embodiments, thethickness T1 may be greater than or less than the central thickness T2.The thickness T1 may range from 2 mm to 18 mm. In some embodiments, thethickness T1 measures 6 mm. The central thickness T2 may range from 2 mmto 12 mm. In some embodiments, the central thickness T2 measures 5 mm.The outer thickness T3 may range from 2 mm to 12 mm. In someembodiments, the outer thickness T3 measures 5 mm. Other thicknesses arecontemplated.

In the pictured embodiment, both the first support members 460 and thesecond support members 465 have a generally rectangular profile. Othershapes, however, are contemplated for the support members, includingwithout limitation, square, oblong, rhomboid, and elliptical shapes. Inparticular, the first support member 460 is shaped as a rectangularplate having the central opening 480. The first support member 460includes two indentations 484 a, 484 b that flank the central opening480 of the first support member 460. As shown in FIG. 12, the firstsupport member 460 includes a height H1. The height H1 may range from 6mm to 54 mm. In some embodiments, the height H1 measures 18 mm. Otherheights are contemplated. Other heights are contemplated. As shown inFIG. 13, the second support member 465 comprises an upper bar 481, alower bar 482, and two walls 483 a, 483 b. The walls 483 a, 483 b havean outer thickness T4. In the pictured embodiment, the outer thicknessT4 is approximately the same as the outer thickness T3 of the firstsupport member 460. In other embodiments, the thickness T4 may begreater than or less than the thickness T3. The outer thickness T4 mayrange from 2 mm to 12 mm. In some embodiments, the outer thickness T4measures 18 mm. Other thicknesses are contemplated. The walls 483 a, 483b of the second support member 465 include notches 486 a, 486 b,respectively. In the pictured embodiment, the notches 486 a, 486 bcomprise hemi-elliptical cutouts in the walls 483 a, 483 b. As shown inFIG. 13, the space between the upper bar 481 and the lower bar 482 ofthe second support member 465 includes a height H2. The height H2 mayrange from 6 mm to 54 mm. In some embodiments, the height H2 measures 18mm. Other heights are contemplated. The second support member 465includes a height H3. The height H3 may range from 10 mm to 80 mm. Insome embodiments, the height H3 measures 30 mm. Other heights arecontemplated.

As shown in FIGS. 10A and 11A, each first support member 460 intersectsthe corresponding second support member 465 by extending through acentral window 487 of the second support member 465. The first supportmember 460 is coupled to the intersecting second support member 465 at acentral hinge 493 aligned with a vertical axis VA that bisects thecentroid of the eyelet 475. As shown in FIGS. 12 and 13, the centralhinge comprises first and second pins 485 a, 485 b, which are insertedthrough the first and second support members 460, 465, respectively,into the top and bottom parts, respectively, of the eyelet 475 along thevertical axis VA. The eyelet 475 is movably or rotatably coupled to thefirst support member 460 and the second support member 465 at thecentral hinge 493 by first and second pins 485 a, 485 b. In the picturedembodiment, the central hinge 493 comprises a pin joint with the firstand second pins 485 a, 485 b extending through channels in the first andsecond support members 460, 465 into the receiving holes 476 a, 476 b inthe eyelet 475. For example, in the pictured embodiment, the first pin485 a extends through the channels 490 a, 490 b in the first and secondsupport members 460, 465, respectively, and the second pin 485 b extendsthrough channels 495 a, 495 b in the first and second support members460, 465, respectively. Thus, the eyelet 475 is coupled to both thefirst and second support members 460, 465 by the first and second pins485 a, 485 b, and can pivot 360 degrees about the vertical axis VAwithin the central opening 480 of the first support member 460.

Returning to FIGS. 10A, 10B, and 11A, adjacent support members 460, 465are hingedly coupled to each other at their ends at outer hinges 486. Insome embodiments, as shown in FIG. 11, the outer hinges 486 comprise pinjoints with pins, bolts, or screws extending through peripheralattachment holes 498, 499 in the first support member 460 and the secondsupport member 465, respectively. In other embodiments, as shown inFIGS. 11B-11D, the outer hinges may comprise living hinges or thinflexible hinges that are continuations of the support membersthemselves. FIGS. 11B-11D illustrate perspective views of a centralportion of an exemplary variable-length support assembly according toanother embodiment of the present disclosure. FIG. 11B illustrates aclose-up perspective view of exemplary support members linked by livinghinges in an expanded configuration according to one embodiment of thepresent disclosure. FIG. 11C illustrates a perspective view of thevariable-length support assembly in an expanded configuration accordingto one embodiment of the present disclosure. FIG. 11D illustrates aperspective view of the variable-length support assembly in a compressedconfiguration according to one embodiment of the present disclosure.

In particular, FIGS. 11B-11D illustrate an exemplary variable-lengthsupport assembly 410′ including outer hinges 486′ that comprise livinghinges or thin flexible hinges made from the same material as the twosupport members 460′, 465′. The variable-length support assembly 410′ issubstantially similar to the variable-length support assembly 410 exceptfor the living hinges described herein. For example, the outer hinges486′ may be made of partially oriented polypropylene, polyethylene, orultra-high molecular weight polyethylene. In such embodiments, the outerhinges 486′ may be sections of wall connecting the support members 460′,465′ that are thinner than the outer thickness T3 of the first supportmember 460′ and the outer thickness T4 of the second support member 465′(as suggested in FIGS. 12 and 13), thereby allowing for flexing alongthe line of the outer hinge 486′ with adequate range of bending andkinematic constraint. In the pictured embodiment, the outer hinges 486′have an arcuate or semi-circular cross-sectional profile when thevariable-length support assembly 410′ is in an expanded condition. Suchliving hinges have minimal friction and low wear, and the low cost andease of manufacturing can be advantageous. In other embodiments, thesupport members 460, 465 may be manufactured as mating halves so thatthe interlaced opposing support members can be assembled from multipleidentical pairs of molded parts or two complementary molded parts. Forexample, in some embodiments, the support members 460′, 465′ may bemanufactured as mating pairs of first and second support members 460′,465′ linked at central hinges 493′. In other embodiments, the supportmembers 460′, 465′ may be manufactured as two separate chains of thefirst support members 460′ and the second support members 465′ linked atthe outer hinges 486′.

Returning to FIG. 4, when the variable-length support assembly 410 iscollapsed in a compressed configuration, the support members 460, 465are positioned adjacent one another. In contrast, as shown in FIGS.6-11A, when the variable-length support assembly 410 is spread out in anexpanded configuration, the support members 460, 465 are spaced apartfrom each other in a scissor-like configuration. More specifically, thesupport members 460, 465 pivot relative to each other at the centralhinges 493 and the outer hinges 486, thereby forcing the eyelets 475 toseparate from one another at regular intervals.

In the pictured embodiment described above with respect to FIGS. 10A and11A in particular, the eyelets 475 align along the insertion axis A asthe catheter 310 passes through them (e.g., when the catheter 310 passesthrough the instrument guiding apparatus 400 in the compressedconfiguration shown in FIG. 4). However, in this embodiment, all theeyelets 475 may not be aligned when the variable-length support assembly410 is returned to a compressed configuration (e.g., without thecatheter 310 passing through the eyelets 475 and maintaining theiralignment). For example, one or more eyelets 475 may be turned along thevertical axis VA such that the catheter may encounter resistance as itis subsequently advanced into the variable-length support assembly 410.In such embodiments, a user may need to manually realign individualeyelets 475 or maneuver the catheter 310 to nudge the eyelets 475 intoproper alignment before advancing the catheter 310.

In other embodiments, the instrument guiding apparatus 400 includesalignment members that ensure that the eyelets 475 are automaticallyaligned to form a pathway for the catheter 310 without needing tomanually readjust individual eyelets 475. For example, FIGS. 15-18Bdescribe two embodiments of variable length support assemblies thatinclude different types of alignment members that facilitate eyeletself-alignment.

FIG. 15 illustrates portions of a variable-length support assembly 500which can be included in instrument guiding apparatus 400. Inparticular, FIG. 15 illustrates an exemplary eyelet 505 having alignmentmembers 510 a, 510 b extending laterally from an outer wall 515. Theeyelet 505 is substantially similar to the eyelet 475 described abovewith reference to FIG. 14 except for the differences described herein.The eyelet 505 is configured to receive pins 485 a, 485 b in receivingholes 506 a, 506 b, respectively, which are positioned on opposite sidesof the eyelet 505. Each alignment member 510 a, 510 b comprises anelongate bar 520 a, 520 b, respectively, which may have a round,rectangular or other prismatic or tapered shape, that optionally alsomay terminate in a protrusion 525 a, 525 b. In the pictured embodiment,the protrusions 525 a, 525 b are shaped as spheres, but otherembodiments may have differently shaped protrusions, such as, withoutlimitation, cubes, tabs, or cones. In other embodiments, the alignmentmembers 510 a, 510 b may lack the protrusions 525 a, 525 b entirely. Thealignment members 510 a, 510 b are fixed to opposite sides of the eyelet505 in a horizontal orientation (i.e., on a horizontal axis HAperpendicular to the vertical axis VA).

FIGS. 16A-16B illustrate portions of a variable-length support assembly501 which can be included in instrument guiding apparatus 400. FIGS. 16Aand 16B illustrate top views of a first support member 530, a secondsupport member 535, the eyelet 505, and the alignment members 510 a, 510b. The first and second support members 530, 535 are substantiallysimilar to the first and second support members 460, 465, respectively,described above except for the differences described herein. FIG. 16Aillustrates a top view of the first and second support members 530, 535in an expanded configuration, whereas FIG. 16B illustrates a top view ofthe first and second support members 530, 535 in a compressedconfiguration. The first support member 530 includes a first indentation540 a and a first groove 541 a on a first wall 545 and a secondindentation 540 b and a second groove 541 b on a second wall 550. Theinner wall comprising the first wall 545 is on an opposite side of thefirst support member 530 than the second wall 550. The second supportmember 535 includes a third indentation 555 a and a third groove 556 aon a first wall 560 and a second indentation 555 b and a fourth groove556 b on a second wall 565. The inner wall comprising the first wall 560is on an opposite side of the second support member 535 than the secondwall 565. The grooves 541 a,b and 556 a,b are shaped and sized tocomplement the shape of the elongate bar 520 a, 520 b, respectively. Theindentations 540 a, 540 b, 555 a, and 555 b are shaped and sized tocomplement the shape of the protrusions 525 a, 525 b. For example, inthe pictured embodiment, the indentations 540 a, 540 b, 555 a, and 555 bhave a hemi-spherical shape corresponding to the spherical shape of theprotrusions 525 a, 525 b. In other embodiments, the indentations 540 a,540 b, 555 a, and 555 b may have a conical shape to help guide theprotrusions 525 a, 525 b into mating positions. When the variable-lengthsupport assembly 501 is in a compressed configuration, the first andsecond support members 530, 535 pivot above the central hinge 493 suchthat the protrusions 525 a, 525 b can be interposed between the firstsupport member 530 and the second support members 535. In particular,the protrusion 525 a is positioned within the indentations 540 a and 555a of the first support member 530 and second support member 535,respectively. The protrusion 525 b is positioned within the indentations540 b and 555 b of the first support member 530 and second supportmember 535, respectively. In some embodiments, the walls of the firstsupport member 530 and the second support member 535 include grooves orelongate indentations (not shown) designed to receive the elongate bars520 a, 520 b interposed therebetween. When the alignment elongate bars520 a, 520 b are interposed between the walls of the support members 530and 535 within grooves or elongate indentations in the walls of supportmembers 530 and 535 or when the protrusions 525 a, 525 b are securedwithin the indentations 540 a, 540 b, 555 a, and 555 b, the eyelet 505is forced into alignment with the other eyelets in the variable-lengthsupport assembly (i.e., with the insertion axis A shown in FIG. 4).

FIGS. 17-18B illustrate portions of an exemplary variable-length supportassembly 690 which can be included in instrument guiding apparatus 400.In particular, FIG. 17 illustrates an exemplary eyelet 605 havingalignment members 611 a, 611 b extending laterally from an outer wall615. The eyelet 605 is substantially similar to the eyelet 475 describedabove except for the differences described herein. FIGS. 18A and 18Billustrate top views of a first support member 630, a second supportmember 635, the eyelet 605, and the alignment members 611 a, 611 b. Thefirst and second support members 630, 635 are substantially similar tothe first and second support members 460, 465, respectively, describedabove except for the differences described herein. FIG. 18A illustratesa top view of the first and second support members 630, 635 in anexpanded configuration, whereas FIG. 18B illustrates a top view of thefirst and second support members 630, 635 in a partially compressedconfiguration. The alignment members 611 a, 611 b are fixed to oppositesides of the eyelet 605 in a horizontal orientation (i.e., on ahorizontal axis HA perpendicular to the vertical axis VA). Eachalignment member 611 a, 611 b comprises an elongate bar 620 a, 620 b,respectively, that extends from the eyelet 605 and telescopicallycouples with additional linkages that connect the elongate bars 620 a,620 b to the support members 630, 635. In particular, the first elongatebar 620 a couples to a first forked linkage 625 a, and the secondelongate bar 620 b couples to a second forked linkage 625 b. The forkedlinkages 625 a, 625 b are three-pronged linkages. The first forkedlinkage 625 a includes three links that each connect to the elongate bar620 a: a central link 626 a telescoping over the elongate bar 620 a, afirst peripheral link 627 a connecting the central link 626 a and theelongate bar 620 a to the first support member 630, and a secondperipheral link 628 a connecting the central link 626 a and the elongatebar 620 a to the second support member 635. The second forked linkage625 b includes three links that each connect to the elongate bar 620 b:a central link 626 b telescoping over the elongate bar 620 b, a firstperipheral link 627 b connecting the central link 626 b and the elongatebar 620 b to the first support member 630, and a second peripheral link628 b connecting the central link 626 b and the elongate bar 620 b tothe second support member 635. Other embodiments may have differentlyshaped linkages shaped and configured to hingedly connect the elongatebars 620 a, 620 b with the support members 630, 635 such that theeyelets 605 are self-aligning when creating a passageway for thecatheter 310.

When the instrument guiding apparatus 400 transitions to a compressedconfiguration, as shown in FIG. 18B, the first and second supportmembers 630, 635 pivot above the central hinge 493 such that the forkedlinkages 625 a, 625 b can be interposed therebetween. In particular, thefirst forked linkage 625 a and the second forked linkage 625 b slideapart in a telescoping manner from the elongate bars 620 a, 620 b,respectively, thereby lengthening the alignment members 611 a, 611 b andallowing the linkages 625 a, 625 b to fold flat between the supportmembers 630, 635. In this embodiment, the alignment members 611 a, 611 bcontinuously guide the eyelet 605 into constant alignment with theinsertion axis A shown in FIG. 4, and consequently, all the othereyelets in the variable-length support assembly that possess similaralignment members. In some embodiments, the linkages 625 a, 625 bcomprise living hinges and function as pivots rather than conventionallinkages.

In another embodiment, as shown in FIGS. 19A-20D, the alignment membersmay comprise torsion springs. FIGS. 19A-19C illustrate an exemplaryeyelet 705 having alignment members 710 a, 710 b extending from an outerwall 715. The eyelet 705 is substantially similar to the eyelet 475described above except for the differences pictured and describedherein. In particular, the alignment members 710 a, 710 b comprisetorsion springs extending from attachment features 722 a, 722 b,respectively. The torsion springs comprising the alignment members 710a, 710 b include coil portions 724 a, 724 b, prong portions 726 a, 726b, and tail portions 728 a, 728 b respectively. The coil portions 724 a,724 b of the torsion springs comprising the alignment members 710 a, 710b wind around the attachment features 722 a, 722 b, respectively. Theprong portions 726 a, 726 b and the tail portions 728 a, 728 b arecontinuous extensions from either end of the coil portions 724 a, 724 bof the alignment members 710 a, 710 b, respectively. The tail portions728 a, 728 b are anchored within the eyelets 705.

FIGS. 20A-20D illustrate perspective views of an exemplaryvariable-length support assembly 720 including the eyelet 705 accordingto one embodiment of the present disclosure. As shown in FIGS. 20A-20D,the alignment members 710 a, 710 b are shaped and configured to applyequal forces between the eyelet 705 and first and second support members730, 735 located on opposite sides of the eyelet 705 as thevariable-length support assembly 720 extends and compresses. The prongportions 726 a, 726 b are sized and shaped to interact with the firstsupport member 730 and second support member 735 of the variable-lengthsupport assembly 720. In the pictured embodiment, the prong portions 726a, 726 b comprise substantially straight, elongate rods that are shapedand sized to apply a biasing force against the first and second supportmembers 730, 735 to maintain the eyelet 705 in alignment with the othereyelets 705 along the central axis CA extending through thevariable-length support assembly 720.

In yet another embodiment, as shown in FIGS. 21 and 22A-22C, thealignment members may comprise spring flexures. FIG. 21 illustrates anexemplary eyelet 805 having alignment members 810 a, 810 b extendingfrom an outer wall 815. The eyelet 805 is substantially similar to theeyelet 475 described above except for the differences described herein.In the pictured embodiment, the alignment members 810 a, 810 b comprisespring flexures extending laterally from opposite sides of the eyelet805.

FIGS. 22A-22C illustrate perspective views of an exemplaryvariable-length support assembly 820 including the eyelet 805 accordingto one embodiment of the present disclosure. The alignment members 810a, 801 b are shaped, sized, and positioned to bear on the faces of firstand second support members 830, 835 continuously over the full range ofopening and closing between them as the variable-length support assembly820 extends and compresses. As shown in FIGS. 22A-22C, the alignmentmembers 810 a, 810 b are shaped and configured to apply biasing forceagainst the first and second support members 830, 835, respectively,located on opposite sides of the eyelet 805 as the variable-lengthsupport assembly 820 extends and compresses. Distal tips 826 a, 826 b ofthe alignment members 810 a, 810 b, respectively, are sized and shapedto interact with the first support member 830 and second support member835, respectively, of the variable-length support assembly 820. In thepictured embodiment, the alignment members 810 a, 810 b comprise curved,elongate bars or arms that are shaped and sized to apply a biasing forceagainst the first and second support members 830, 835 to maintain theeyelet 805 in alignment with the other eyelets 805 along the centralaxis CA extending through the variable-length support assembly 820.

In another embodiment, as shown in FIGS. 23 and 24A-24C, the alignmentmembers may comprise magnets. While magnets can provide for alignment ofeyelets along the insertion axis, the magnets may also be used to retainvariable length support assembly 920 in a compressed configuration forstowage, replacing or supplementing a latch mechanism such as retainingassembly 420 FIG. 23 illustrates an exemplary eyelet 905 havingalignment members 910 a, 910 b coupled to an outer wall 915. The eyelet905 is substantially similar to the eyelet 475 described above exceptfor the differences described herein. In the pictured embodiment, thealignment members 910 a, 910 b comprise magnets having pole axes alignedwith a longitudinal axis LA of a lumen 925 in each eyelet 905. In thepictured embodiment, the alignment members 910 a, 910 b comprisecylindrical magnets that are seated within the outer wall 915. Thealignment members 910 a, 910 b are positioned approximately 180 degreesapart from one another and aligned along a horizontal axis HA, whichextends through the center of the lumen 925. In other embodiments, themagnetic alignment members 910 a, 910 b may be positioned in differentarrangements relative to the lumen and to each another. For example,magnets can comprise rings which are concentrically seated around lumen920. Eyelet 905 can include a first ring magnet seated on a distalsurface of eyelet 905 and a second ring magnet seated on a proximalsurface of eyelet 905 allowing adjacent eyelets 905 withinvariable-length support assembly 920, to mate and magnetically attractwhen the variable-length support assembly is in the compressedconfiguration.

FIGS. 24A-24C illustrate perspective views of an exemplaryvariable-length support assembly 920 including the eyelet 905 accordingto one embodiment of the present disclosure. The alignment members 910a, 901 b are shaped, sized, and positioned to maintain the eyelets 905in alignment along the central axis CA extending through the lumens 925continuously over the full range of extension and compression of thevariable-length support assembly 920. As shown in FIGS. 24A-24C, thealignment members 910 a, 910 b are arranged such that magneticattraction between the alignment members of adjacent eyelets 905maintains the alignment of the eyelets 905 as the variable-lengthsupport assembly 920 extends and compresses. In the pictured embodiment,the magnetic attraction between the alignment members 910 a, 910 b ofadjacent eyelets 905 to maintain the adjacent eyelets 905 in alignmentwith each other and, consequently, with the other eyelets 905 arrangedin series along the central axis CA, which extends through thevariable-length support assembly 920.

The alignment members 910 a, 910 b on opposite sides of the eyelets 905may be positioned within the eyelets 905 to have opposite polarities. Inother words, the alignment members 910 a of adjacent eyelets 905 mayhave opposite polarities, and the alignment members 910 b of adjacenteyelets 905 may have opposite polarities. Thus, the facing walls ofadjacent eyelets 905 in the variable-length support assembly 920 mayhave opposite polarities causing the eyelets 905 to align. Inparticular, the alternating polarities will force the eyelets to alignalong the central axis CA (and the insertion axis A) as thevariable-length support assembly 920 retracts toward the fully closedconfiguration. This ensures that whenever the variable-length supportassembly 920 is retracted without a flexible instrument inserted throughthe eyelets 905, the eyelets 905 will align themselves as thevariable-length support assembly 920 reaches its fully retractedconfiguration, thus preventing a misaligned eyelet 905 from interferingwith full retraction of the variable-length support assembly 920. Suchmagnetic alignment members 910 a, 910 b may also eliminate the need fora mechanical latch (such as the retaining assembly 420 described above)to hold the assembly 920 closed when not attached at both ends to theflexible instrument manipulator system (i.e., the instrument interfaceportion 300).

As described above, the variable-length support assemblies can supportthe catheter 310 shown in FIG. 3 along its changing external (i.e.,positioned outside the patient anatomy P) length as it enters or exitsthe patient anatomy P (shown in FIG. 1). When the variable-lengthsupport assembly is in a compressed configuration, the alignment membersforce the eyelets to self-align along a common axis (e.g., the insertionaxis). When the catheter 310 is threaded through the support assembly,the catheter 310 is automatically aligned along the insertion axis andis protected from buckling by being supported at regular intervals ateach eyelet. With the support members in an expanded configuration, thesupport assembly minimizes bending or buckling of the catheter 310 asthe distal end of the catheter is advanced into the patient anatomy P.Any significant bending or buckling of the catheter 502 may damageoptical fibers used for shape sensing or endoscopy or damage thecatheter itself. Also, bending or buckling may make advancing thecatheter non-intuitive, since the user will observe no distal tipmovement even though the user is advancing the proximal end of thecatheter.

FIGS. 10A-10E illustrate a proximal portion of the variable-lengthsupport assembly shown in FIG. 4. In particular, FIGS. 10A-10Dillustrate perspective views of an exemplary proximal arm synchronizingassembly 600, and FIG. 10E illustrates a top view of the proximal armsynchronizing assembly 600 according to one embodiment of the presentdisclosure. The proximal arm synchronizing assembly 600 is connected tothe proximal coupler 405, and serves to constrain the motion of thevariable-length support assembly 410. In particular, the proximal armsynchronizing assembly 600 ensures that the variable-length supportassembly 410 extends and retracts in alignment with the central axis CA(shown in FIGS. 7-9) extending through the proximal coupler 405 and theeyelets 475.

In the pictured embodiment, the proximal arm synchronizing assembly 600comprises at least two spools 605 a and 605 b. The spools 605 a, 605 bare coupled to the proximal arms 470 a, 470 b, respectively. In someembodiments, the spools 605 a, 605 b are integral features of theproximal arms 470 a, 470 b, respectively. Each spool 605 a, 605 b maycomprise two separate spools (i.e., an upper spool and a lower spool)that are independently coupled to the upper and lower cables 610 a, 610b, respectively. For the sake of simplicity, each set of upper and lowerspools is referred to herein as two single spools 605 a, 605 b. It isunderstood that the upper and lower spools may operate independently ofone another, and may wind in opposing directions to synchronize themotion of the proximal arms 470 a, 470 b and the support members 460,465. The cables 610 a, 610 b are wound around the spools 605 a, 605 b inopposing S-shapes to (1) synchronize the proximal arms 470 a, 470 b, (2)to equally actuate the first and second support members 460, 465 of thevariable-length support assembly 410 relative to one another, and (3) tostabilize and steady the connection between the proximal coupler 405 andthe variable-length support assembly 410 to prevent sagging of thevariable-length support assembly 410 if the attachment of distal coupler415 to an anchor such as anchor 317 of FIG. 3, is released by a userwhile a catheter is threaded through the variable-length supportassembly 410. In particular, the cable 610 a is wound about upperportions 612 a, 612 b of the spools 605 a, 605 b, respectively, and thecable 610 b is wound about lower portions 614 b, 614 b of the spools 605a, 605 b, respectively. The spool 605 b includes at least one tensioningelement 608 that is coupled to one end of the cable 610 a. In thepictured embodiment, as shown in FIG. 10B, the tensioning element 608 isrotatable in the directions indicated by arrows A3, A4 about a verticalaxis VA extending through the center of the spool 605 b. Rotation of thetensioning element 608 acts to increase or decrease the tension in thecable 610 a. For example, in the pictured example, rotation of thetensioning element 608 in the direction of the arrow A3 acts to decreasethe tension on the cable 610 a and rotation of the tensioning element608 in the direction of the arrow A4 (i.e., the opposite direction) actsto increase the tension on the cable 610 a. The tensioning element 608includes an engagement feature 609 that facilitates the rotation of thetensioning element 608. In the pictured embodiment, the engagementfeature 609 is an indentation on the tensioning element 608. Theengagement feature 609 can selectively couple with a tool configured torotate or otherwise adjust the tensioning element 608.

Because the upper and lower cables 610 a, 610 b are wound in oppositedirections, the tensions in these cables 610 a, 610 b prevent unequalmotion of the proximal arms 470 a, 470 b in respective oppositedirections, thereby ensuring that the proximal arms 470 a, 470 b alwaysopen and close while maintaining equal but opposite angles with respectto the center axis CA of the variable-length support assembly 410.Increasing the tension on the cable 610 a serves to increasinglyconstrain the motion of the support members. Thus, the cables 610 a, 610b of the proximal arm synchronizing assembly 600 effectively constrainthe support members 460, 465 of the variable-length support assembly 410to move along the center axis CA.

In other embodiments, as shown in FIGS. 25A-25C, sets of gears withequal numbers of teeth may be substituted for the spools 605 a, 605 band provide the same constraint on motion of the proximal arms 470 a,470 b. In particular, FIGS. 25A-25C illustrate perspective views of anexemplary variable-length support assembly 950 coupled to a proximal armsynchronizing assembly 955 and a distal arm synchronizing assembly 960according to one embodiment of the present disclosure. FIG. 25Aillustrates the length of the variable-length support assembly 950. FIG.25B illustrates the proximal arm synchronizing assembly 955 coupled tothe variable-length support assembly 950, and FIG. 25C illustrates thedistal arm synchronizing assembly 960 according to one embodiment of thepresent disclosure. In the pictured embodiment, the variable-lengthsupport assembly 950 includes a plurality of first support members 962coupled to second support members 964. The proximal arm synchronizingassembly 955 is connected to the proximal coupler 405, and serves toconstrain the motion of the variable-length support assembly 950. Inparticular, the proximal arm synchronizing assembly 955 ensures that thevariable-length support assembly 950 extends and retracts in alignmentwith the central axis CA extending through the proximal coupler 405, theeyelets 475, and the distal coupler 415.

In the pictured embodiment, the proximal arm synchronizing assembly 955comprises four gear elements 965 a, 965 b, 965 c, and 965 d. The gears965 a and 965 c comprise one side of the proximal arm synchronizingassembly 955, and the gears 965 b and 965 d comprise the other side ofthe proximal arm synchronizing assembly 955. The gears 965 a and 965 cof the proximal arm synchronizing assembly 955 are coupled to theproximal arm 470 a, and the gears 965 b and 965 d of the proximal armsynchronizing assembly 955 are coupled to the proximal arm 470 b. Insome embodiments, the gears 965 a-d are integral features of theproximal arms 470 a, 470 b. It is understood that the upper gears 965 a,965 b and the lower gears 965 c, 965 d turn in opposing directions tosynchronize the motion of the proximal arms 470 a, 470 b and the supportmembers 962, 964. The gears 965 a-d operate to (1) synchronize theproximal arms 470 a, 470 b, (2) to equally actuate the first and secondsupport members 962, 964 of the variable-length support assembly 950relative to one another, and (3) to stabilize and steady the connectionbetween the proximal coupler 405 and the variable-length supportassembly 950. Rotation of the gears 965 a-d acts to constrain the motionof the proximal arms 470 a, 470 b to move through equal and oppositeangles.

The distal arm synchronizing assembly 960 is substantially similar instructure and function to the proximal arm synchronizing assembly 955includes four gear elements 970 a, 970 b, 970 c, and 970 d. The gears970 a and 970 c comprise one side of the distal arm synchronizingassembly 960, and the gears 970 b and 970 d comprise the other side ofthe distal arm synchronizing assembly 960. The gears 970 a and 970 c ofthe distal arm synchronizing assembly 960 are coupled to the distal arm472 a, and gears 970 b and 970 d of the distal arm synchronizingassembly 960 are coupled to the distal arm 472 b. In some embodiments,the gears 970 a-d are integral features of the distal arms 472 a, 472 b.

Although a single set of gears could provide constraint against motionin both opposite transverse directions, it is noted that multiple setsof gears could share the load, thus allowing the arm synchronizingassemblies to withstand higher side loads than a single set of gears.

FIGS. 26A-2B illustrate perspective views of an exemplary instrumentguiding apparatus 1000 according to another embodiment of the presentdisclosure. Instrument guiding apparatus 1000 can include avariable-length support assembly 1010 and an arm synchronizing assemblywhich can comprise a proximal arm synchronizing assembly 1020 and adistal arm synchronizing assembly 1030. Instrument guiding apparatus1000, variable-length support assembly 1010, proximal arm synchronizingassembly 1020, and distal arm synchronizing assembly can besubstantially similar to imaging guiding apparatus 400, variable-lengthsupport assembly 410, proximal arm synchronizing assembly 955, anddistal arm synchronizing assembly 960 respectively, except for thedifferences described herein. FIG. 26A displays the instrument guidingapparatus 1000 from a top perspective while FIG. 26B displays theinstrument guiding apparatus 1000 from a bottom perspective.

Proximal arm synchronizing assembly 1020 can comprise a first gear pair1025 a/1025 b and a second gear pair 1025 c/1025 d positioned at theproximal end of the variable-length support assembly 1010. The gears1025 a-1025 d can be substantially similar in structure and function togears 965 a-965 d except for the differences described herein. In theillustrated embodiment, gears 1025 a-1025 d require less than 360 degreerotation to provide engagement of teeth during full extension andcollapse of variable-length support assembly 1010. Thus gears 1025 b and1025 d can be shaped as circular gear with a partial circumference ofteeth as illustrated in FIGS. 26A, 26B, and 27A. Gears 1025 a and 1025 ccan also include a partial circumference of teeth but as illustrated inFIGS. 26A, 26B, and 27A, gears 1025 a and 1025 c can each be shaped as awedge instead of a circular gear. In an alternative embodimentillustrated in FIG. 27B, both gears may be shaped as wedges with acurved surface for a partial circumference of teeth. In yet anotherembodiment (not shown), both gears may be shaped as circular gears witha partial circumference of teeth.

In some embodiments, gears may provide potential pinch points foroperators causing a safety concern. As illustrated in FIG. 27A, gear1025 a can include guard 1035 a providing protection from a pinch-pointbetween engaged teeth in gear pair 1025 a/1025 b. The single guard 1035a extending over the gear pair 1025 a/1025 b, allows for free rotationalmotion of the guard during expansion and compression of thevariable-length support assembly 1010. In an alternative embodimentillustrated in FIG. 27B, gear 1025 a′ can be identical to gear 1025 abut oriented in a mirrored image allowing guard 1035 a′ to rotate in adifferent plane than guard 1035 a, avoiding interference between theguards. Gear pair 1025 c/1025 d may be substantially similar instructure and function as gear pair 1025 a/2015 b. Retelling back toFIGS. 26A and 26B, an enclosure 3000 may be provided which will bedescribed in further detail below. In an alternative embodiment (notshown), the enclosure can be extended to cover gear pairs 1025 a/1025 band 1025 c/1025 d, replacing guard 1035 a and 1035 c, and providingprotection from potential pinch points.

The distal arm synchronizing assembly 1030 is substantially similar instructure and function to the proximal arm synchronizing assembly 1020.It should be understood that the distal synchronizing arm 1030 and theproximal arm synchronizing assembly 1020 can also include assembliessubstantially similar to those described for synchronizing armassemblies 600 including spools 605 a and 605 b and/or gears elements965 a, 965 b, 965 c, and 965 d. The proximal arm synchronizing assembly1020 and distal arm synchronizing assembly 1030 can use any combinationof spools and gear assemblies, including any variation of gearembodiments described herein.

FIG. 28 illustrates a cross sectional view of the variable-lengthsupport assembly 1010 in a collapsed state with eyelets 1040 rotatablycoupled to the support members 2010 using pins 2020. The eyelets 1040are substantially similar to eyelet 475 and eyelet 905 disclosed aboveexcept for the differences described herein. In the pictured embodimentillustrated in FIG. 29A, the eyelet 1040 includes a body 1042 includinga rectangular shaped distal surface 1045, a corresponding proximalsurface 1055, and a lumen 1065 extending therebetween. The lumen 1065may include chamfered edges where it terminates at the surfaces 1045,1055 to permit easy passage of an instrument such as catheter 310, asdescribed above for eyelet 705, eyelet 805, and eyelet 905. It should beunderstood that while eyelet 475, eyelet 505, and eyelet 605 are notillustrated with chamfered lumens, each eyelet can include chamfers foreasy passage of the catheter 310. The body 1042 also includes an uppersurface 1043 a and a bottom surface 1043 b.

As shown in FIGS. 29A and 29B, eyelet 1040 can also include alignmentmembers 1075 a-1075 d. In this embodiment, alignment members 1075 a-1075d are projections that extend laterally away from the body 1042. Theedges of each alignment member 1075 a-1075 d can be curved away from thedistal surface 1045 and away from the proximal surface 1045 toward alateral tip 1076 a-1076 d, thus forming a tapered profile. In theembodiment of FIG. 29A, the tips 1076 a-1076 d are rounded and symmetricabout a rotational axis R through the body 1042. In some embodiments,the ratio of the radius of curvature of the tip 1076 a to the are lengthof the curved face of alignment member 1075 a may be in a range of0.0250-0.500. In one embodiment, for example, the radius of curvature ofthe tip 1076 a may be 0.200 mm and the are length of the curved face ofalignment member 1075 a may be approximately 5.100 mm. The tips 1076a-1076 d may be continuously curved or may have a non-curved lengthbounded by surfaces with a radius of curvature. The outer edges of thealignment members 1075 a-1075 d may be curved away from the uppersurface 1043 a or the bottom surface 1043 b toward the tips 1076 a-1076d. When the variable-length assembly 1010 is in an expanded orun-collapsed configuration without an elongated flexible memberextending through the eyelets 1040, the eyelets may be freely rotatable,for example, between 0° and 360°. The shape of the alignment members1075 a-1075 d allows for self-alignment with adjacent eyelets 1040 asthe support assembly 1010 is collapsed, resulting in the alignedstacking of adjacent eyelets 1040 such that the distal surface 1045 ofone eyelet 1040 faces the proximal surface 1055 of an adjacent eyelet1040. When the adjacent eyelet alignment members contact each other asthe assembly is collapsed, the curved edges and tapered profile of thealignment members bias the series of eyelets 1040 toward alignment alonga longitudinal axis through the lumen 1065. Once the alignment members1075 a-1075 d of adjacent eyelets 1040 make contact with one another,the shape of the alignment members urge the eyelets 1040 into a stackedconfiguration such that the lumen 1065 of each of the eyelets 1040 arealigned. As viewed from a top perspective in FIG. 29B, the upper surface1043 a of eyelet 1040 can include a rectangular profile with thealignment members 1075 a and 1075 c extending away from the uppersurface 1043 a toward pointed oval ends.

FIGS. 30A and 30B illustrate an alternative embodiment of an eyelet 1050with tapered alignment members 2005 a-2005 d. Alignment member 2005 acurves from a distal surface 1085 towards a proximal surface 1095 toform a lateral tip 2006 a while alignment member 2005 c curves from theproximal surface 1095 towards the distal surface 1085 to form a lateraltip 2006 c. A top view of eyelet 1050 is illustrated in FIG. 30Bdisplaying the curved shape of the tapered alignment members 2005 a-2005d including a curved parallelogram top profile with tips 2006 a and 2006c. In some embodiments, the curved lateral surfaces of the parallelogrammay be formed from a major curve, and the tip may be formed with a minorcurve. The ratio of the radius of curvature of the minor curve to themajor curve may be approximately 0.050-0.100. In one embodiment, forexample, the minor curve forming the tip may have a radius of curvatureof approximately 0.600 mm and the major curve forming the lateral curvedsurface of the parallelogram may be approximately 8.0 mm. In theembodiment of FIGS. 30A and 30B, the tips 2006 a and 2006 c are rounded,and the alignment member and tips are asymmetric about a rotational axisR through the eyelet 1050.

The shape of eyelets 1040 and 1050 can allow for more reliableself-alignment than other shapes. Non-curved alignment members couldcollapse into orthogonally misaligned positions relative to each otherdepending on an initial misalignment. For example, if a square orrectangular eyelet were misaligned by 90 degrees (i.e. rotated by 90degrees about a longitudinal axis of a pin such as pin 2020), themisaligned eyelet would remain in the orthogonally misalignedconfiguration as the instrument guiding apparatus is collapsed. An ovalshaped profile could help avoid a 90 degree misalignment but could stilltend to lock in an orthogonally misaligned configuration. The shape ofeyelet 1040 and eyelet 1050 include curved edges which converge to acurved point, the curved point helping to avoid locking in any initialmisaligned configuration.

Referring back to FIGS. 26A and 26B, the enclosure 3000 can provide ahousing for electronics such as printed circuit boards (PCBs) andsensors associated with the instrument guiding apparatus 1000, and/ormechanical fasteners including latches, mounting screws, magneticconnections, etc. for fixing the instrument guiding apparatus 1000 to anassembly such as teleoperational manipulator assembly 102 withinteleoperated medical system 100. In one example, an instrument guidingapparatus PCB 3020 may be provided with electrical pads 3025 configuredto mate with corresponding pogo pins on a system PCB (not shown)provided on the teleoperational manipulator assembly 102. A controllerwithin the teleoperated medical system 100 can monitor and count afrequency of connecting and disconnecting the pogo pins with the systemPCB in order to determine the number of times variable-length supportassembly 1010 is mounted to the teleoperational manipulator assembly102. In an alternative embodiment, the PCB can be replaced with apresence sensor indicating installation and/or removal of the instrumentguiding apparatus 1000. In some embodiments, the presence sensor may bea life cycle indicator if the instrument guiding apparatus 1000 has alimited number of life cycles. The controller can save the number ofconnections of instrument guiding apparatus 1000 and provide anindication to the user when a new instrument guiding apparatus 1000 mustbe used for a next medical procedure. In one example, the supportassembly PCB can include identification information and the controllercan record a number of uses of the instrument guiding apparatus 1000correlated to a specific identification part number representing thespecific instrument guiding apparatus 1000. The enclosure 3000 may alsoinclude a coupling mechanism for detachably coupling an end of theinstrument guiding apparatus 1000 to the teleoperational manipulatorassembly 102 (not shown). In the illustrated embodiment of FIGS. 26A and26B, the housing may include a pair of latches 3015 which can beactuated with buttons 3010 positioned on the outer surface of theenclosure 3000. The buttons may be depressed to compress the latches tomate with corresponding attachment elements (not shown) on theteleoperational manipulator assembly 102. In alternative embodiments thecoupling mechanism may include any type of fastening element such assnap-fit engagements, frictional engagements, hook-and-eye fasteners,pins, magnetic fasteners, bolts (e.g. carriage bolts), screws (e.g.mating screws, thumb screws), and/or the like.

As illustrated in FIGS. 26A and 26B, a distal coupler 2050 may also beprovided to detachably couple the distal end of the instrument guidingapparatus 1000 to a portion of the teleoperational manipulator assembly102 such as a support arm included within the teleoperationalmanipulator assembly 102 (not shown). The distal coupler 2050 mayinclude a C-shaped clamp constructed from a flexible material which canflex open with pressure to be installed onto the support arm and returnto an original shape to lock onto the support arm. The support arm mayinclude slots (not shown) which can mate with protrusions 2055 on thedistal coupler 2050.

In alternative embodiments, the enclosure 3000 may be included on thedistal end of the instrument guiding apparatus 1000 only or on both thedistal and proximal ends of the instrument guiding apparatus 1000.Alternatively, a coupler such as illustrated in FIG. 26A may be includedon the distal and/or proximal ends of instrument guiding apparatus 1000.Additionally, while the enclosure 3000 is illustrated in FIGS. 26A and28B with respect to instrument guiding apparatus 1000, it should beunderstood that the enclosure 3000, electronics, mechanical fasteners,and controllers for counting of variable-length support assembly lifecycles can be implemented within any embodiments of instrument guidingapparatus including but not limited to instrument guiding apparatus 400.

Assembly of an instrument guiding apparatus can require a complicatedand time consuming assembly process. FIG. 31A illustrates an example ofan assembly fixture 3500 for assembly of an instrument guiding apparatus2500 which can facilitate an assembly process by providing a holdingstructure allowing for the instrument guiding apparatus 2500 to beassembled in separate sub-assembly layers. By providing separatesub-layers in a modular fashion, part count may be reduced, reducingcost and assembly time. FIG. 31A illustrates the instrument guidingapparatus 2500 fully assembled within the assembly fixture 3500.Instrument guiding apparatus 2500 can include a proximal coupler 2505, adistal coupler 2515, and a variable-length support assembly 2510, whichcomprises support members 2520, and eyelets 2530. As illustrated in FIG.31B, each support member 2520 can include a lower support member 2525,an upper support member 2545, and an interior support member 2535. Whileassembly fixture 3500 is illustrated with instrument guiding apparatus2500, it should be understood that assembly fixture 3500 can be used ina similar manner as described herein with instrument guiding apparatus400, 960, and 1000 which are similar in structure and function toinstrument guiding apparatus 2500.

FIG. 31B shows a single support member 2520 in an exploded configurationfor illustration. During assembly of the instrument guiding apparatus2500, a first subassembly layer can include the lower support members2525 which can be loaded into slots 3510 within the assembly fixture3500 which provides a stable support structure allowing for assembly ofthe instrument guiding apparatus 2500 in separate subassembly layers. Asecond subassembly layer including the eyelets 2530, interior supportmembers 2535, pins 2550 for rotatably coupling the eyelets 2530 to theinterior support members 2535 and the lower support members 2525, andpins 2540 for coupling lower support members 2525 to the interiorsupport members 2535. The distal coupling 2515 and proximal coupling2505 can then be fitted at the ends of the variable length supportassembly 2500. A third subassembly layer can include the upper supportmembers 2545 which can be snapped into the lower support members usingmechanical snap retainers. The assembly process allows for an easymethod of assembly without the use of adhesive, screws, and otherfasteners requiring the use of tools.

The systems and methods of this disclosure are suited for use in theconnected bronchial passageways of the lung, as well as for navigationand treatment of other tissues, via natural or surgically createdconnected passageways, in any of a variety of anatomical systemsincluding the colon, the intestines, the kidneys, the brain, the heart,the circulatory system, the reproductive system, or the like. Themethods and embodiments of this disclosure are also suitable fornon-interventional applications.

One or more elements in embodiments of the invention may be implementedin software to execute on a processor of a computer system such ascontrol system 112. When implemented in software, the elements of theembodiments of the invention are essentially the code segments toperform the necessary tasks. The program or code segments can be storedin a processor readable storage medium or device that may have beendownloaded by way of a computer data signal embodied in a carrier waveover a transmission medium or a communication link. The processorreadable storage device may include any medium that can storeinformation including an optical medium, semiconductor medium, andmagnetic medium. Processor readable storage device examples include anelectronic circuit; a semiconductor device, a semiconductor memorydevice, a read only memory (ROM), a flash memory, an erasableprogrammable read only memory (EPROM); a floppy diskette, a CD-ROM, anoptical disk, a hard disk, or other storage device, The code segmentsmay be downloaded via computer networks such as the Internet, intranet,etc.

Note that the processes and displays presented may not inherently berelated to any particular computer or other apparatus. The requiredstructure for a variety of these systems will appear as elements in theclaims. In addition, the embodiments of the invention are not describedwith reference to any particular programming language. It will beappreciated that a variety of programming languages may be used toimplement the teachings of the invention as described herein.

While certain exemplary embodiments of the invention have been describedand shown in the accompanying drawings, it is to be understood that suchembodiments are merely illustrative of and not restrictive on the broadinvention, and that the embodiments of the invention not be limited tothe specific constructions and arrangements shown and described, sincevarious other modifications may occur to those ordinarily skilled in theart.

What is claimed is:
 1. An apparatus for guiding an elongated flexibleinstrument, the apparatus comprising: a variable-length support assemblyincluding: a first end; a second end; a plurality of support memberpairs, each support member pair comprising a first support member linkedto a second support member; and a plurality of eyelets configured toreceive the elongated flexible instrument, each of the plurality ofeyelets movably coupled to at least one of the plurality of supportmember pairs along a longitudinal central axis between the first end andthe second end, wherein the variable-length support assembly isconfigured to selectively transition from a compressed configuration toan expanded configuration along the longitudinal central axis, andwherein the plurality of eyelets are adapted to support the elongatedflexible instrument as the elongated flexible instrument is advancedalong the longitudinal central axis, and wherein each of the pluralityof eyelets includes a tapered alignment member configured to contact atapered alignment member of an adjacent eyelet to move the plurality ofeyelets into alignment along the longitudinal central axis as thevariable-length support assembly transitions from the expandedconfiguration to the compressed configuration.
 2. The apparatus of claim1, wherein each of the plurality of eyelets comprise a chamfered lumenfor receiving the elongated flexible instrument.
 3. The apparatus ofclaim 1 wherein the first support member includes an upper supportportion, an interior support portion, and a lower support portion,wherein the upper support portion extends through the interior supportportion to couple to the lower support portion.
 4. The apparatus ofclaim 3 wherein the lower support portion extends through the interiorsupport portion to couple to the upper support portion.
 5. The apparatusof claim 1, wherein adjacent support member pairs are connected to eachother by outer hinges.
 6. The apparatus of claim 1, further comprising aproximal coupler at the first end of the variable-length supportassembly, the proximal coupler configured to couple the variable-lengthsupport assembly to an instrument interface portion.
 7. The apparatus ofclaim 6, wherein the proximal coupler includes a proximal aperture sizedto receive the elongated flexible instrument, wherein the proximalaperture is aligned with the plurality of eyelets along the longitudinalcentral axis.
 8. The apparatus of claim 6, further comprising a proximalarm synchronizing assembly coupled to the proximal coupler and thevariable-length support assembly, the proximal arm synchronizingassembly configured to equally actuate the first and second supportmembers relative to the longitudinal central axis and relative to eachother.
 9. The apparatus of claim 8, the proximal arm synchronizingassembly comprising a pair of spools and a set of cables wound inopposing S-shapes about the pair of spools.
 10. The apparatus of claim8, the proximal arm synchronizing assembly comprising a pair of gears.11. The apparatus of claim 6, further comprising a retaining assemblycoupled to the proximal coupler, the retaining assembly configured toselectively retain the variable-length support assembly in a compressedconfiguration.
 12. The apparatus of claim 11, further comprising anattachment element at a distal end of the variable-length supportassembly, wherein the retaining assembly selectively engages theattachment element to retain the variable-length support assembly in thecompressed configuration.
 13. The apparatus of claim 1, furthercomprising a distal coupler at the second end of the variable-lengthsupport assembly, the distal coupler configured to couple thevariable-length support assembly to an anchor in a surgical field. 14.The apparatus of claim 1, wherein, for each eyelet of the plurality ofeyelets, the first and second support members of the at least one of theplurality of support member pairs include indentations having acorresponding shape to the tapered alignment member, wherein the taperedalignment member is interposed between the indentations of the first andsecond support members when the variable-length support assembly assumesthe compressed configuration.
 15. The apparatus of claim 1, furthercomprising a torsion spring extending between each of the plurality ofeyelets and respective first and second support members.
 16. Theapparatus of claim 1, further comprising a pair of magnets coupled to aset of adjacent eyelets and positioned between the adjacent eyelets. 17.The apparatus of claim 16, wherein the pair of magnets comprises a firstmagnet coupled to a first eyelet of the set of adjacent eyelets and asecond magnet coupled to a second eyelet of the set of adjacent eyelets,the first magnet having an opposite polarity of the second magnet. 18.The apparatus of claim 1, further comprising a spring flexure extendingbetween each of the plurality of eyelets and respective first and secondsupport members.
 19. The apparatus of claim 1 further comprising asensor adapted to count each use of the variable-length supportassembly.
 20. The apparatus of claim 1, wherein each of the plurality ofeyelets is freely rotatable about a rotation axis perpendicular to thelongitudinal central axis when the variable-length support assembly isin the expanded configuration.